酮咯酸胺丁三醇对颈丛阻滞麻醉下甲状腺手术中应激反应的影响

摘要

Objective :To observe the impact of Ketorolac Tromethamine on the stress response during the cervical plexus block in the thyroid surgery .Methods :75 patients who were going to take the thyroid surgery , with ASA classifying I‐II ,were divided to fentanyl group (F group) ,Ketorolac Tromethamin group(KT group) and control group(C group) randomly .Each group has 25 patients .After the deep cervical plexus block at the affected side and the superficial cervical plexus block at the two sides ,0 .5 mg/kg Ketorolac Tromethamine was injected in KT group while 2μg/kg fentanyl and equal saline was injected in F group and C group respectively .The glucose and the plasma cortisol were tested at three points :entring the OR(T0 ) ,skin incision(T1 ) and one hour after(T3 ) .BP , pules and SpO 2 were monitored during the operations ,as while as the MAP ,HR and SpO2 were recorded during T 0 , T1 ,T2 (surgical exploration)and T 3 .Urapidil would be used when the BP raised by 30% while Esmolol would be used when the HR raised by 30% than pre‐operation state .Results :MAP and HR at T 1 and T2 were higher than at T0 in three groups(P< 0 .05 ,P< 0 .01) ,but the variation of MAP and HR in KT group was lower than in F group and in C group(P< 0 .05) .The SpO2 in F group was lower than in KT group and in C group at T 1 .Though the glu‐cose and plasma cortisol raise in the three groups after the starting of operation (P< 0 .05) ,the level in KT group was lower than in C group and in F group(P< 0 .05) .Less urapidil and esmolol were used in KT group than in C group and in F group(P< 0 .01) .Conclusion :Comparing with fentanyl ,Ketorolac Tromethamine has better effect on inhib‐iting stress response and less respiratory depression in cervical plexus block in thyroid surgery .%目的：观察酮咯酸胺丁三醇（尼松）对颈丛阻滞麻醉下甲状腺手术中应激反应的影响。方法：将 ASA 分级在 I ～ II 级，拟施择期甲状腺手术的成年患者75例，随机分为芬太尼组（F 组）和酮咯酸胺丁三醇组（KT 组）和空白对照组（C 组）3组，每组25例，所有患者在进行患侧颈深丛，双侧颈浅丛阻滞麻醉成功后，KT 组静注酮铬酸胺丁三醇0．5 mg ／kg ，F 组静注芬太尼2μg／kg ，C 组静注等量生理盐水，分别于患者入室（T0），手术切皮（T1）及手术开始1 h（T3）3个时点监测血糖（Glu）和血浆皮质醇（Cor）。术中监测血压、心率和指脉氧饱和度，记录 T0、T1，手术探查时（T 2）、T34个时点的平均动脉压（MAP）、心率（HR）和指脉氧饱和度（SpO2），如血压较术前升高＞30％，加用乌拉地尔控制血压，如心率较术前增快＞30％，使用艾司洛尔降低心率。结果：3组患者在切皮时（T 1）和手术探查（T2）两个时点的 MAP 和 HR 均高于患者入室（T0）（P ＜0．05，P ＜0．01），但KT 组的 MAP 和 HR 变化低于对照组和芬太尼组（P＜0．05），F 组在手术切皮（T1）时的 SpO2低于KT 组和 C 组。3组患者的 Glu 和 Cor 水平均较术前升高（P＜0．05），但 KT 组低于 C 组和 F 组（P＜0．05）。 KT 组使用艾司洛尔和乌拉地尔的量少于 C 组和 F 组（P＜0．01）。结论：酮咯酸胺丁三醇（尼松）较芬太尼，能够更好的抑制颈丛阻滞麻醉下甲状腺手术中应激反应，而且更少出现呼吸抑制。